The goal of the proposed project is to follow up and evaluate at age 7 a cohort of low income urban children who have participated in the Childhood Asthma Prevention Study (CAPS) since their enrollment prior to age 2. CAPS is a Demonstration and Education randomized, controlled intervention study, now in its 5th year of funding, that has been aimed at reducing asthma prevalence, severity, and morbidity among low income, urban children. Children ages 9-24 months with documentation of multiple wheezing episodes and additional risk factors for childhood asthma were enrolled. They received a nurse home visitor intervention that targeted allergens in the home, environmental tobacco smoke exposure, and quality of maternal caregiving, particularly in relation to asthma prevention and management. Original study goals included following the children to age 4. At this time almost half of the children have reached their 4th birthday and have been evaluated for asthma. Preliminary data suggest that the intervention may have been effective in reducing asthma at age 4. However, asthma at age 4 is a mixture of asthma phenotypes that will become much more clear by the time the children reach age 7. Thus, evaluating the children for asthma at age 7 will provide valuable information regarding the effects of the intervention. Further, for 4-year-olds methods for obtaining objective assessments of pulmonary functions are still under development, whereas by age 7 children can perform spirometry adequately to derive objective measures. Besides evaluating the long-term effects of the intervention, follow-up of the cohort to age 7 will provide an opportunity for a detailed examination of psychosocial, environmental, and ethnicity factors that were shown in baseline analyses to be associated with initial outcomes. Finally, the follow-up provides a unique opportunity to investigate the role of concurrent caregiver mental health on asthma morbidity and related health care utilization among these low-income children. We plan to obtain objective evaluations of cigarette smoke exposure (cotinine) and asthma medication adherence (electronic monitoring) at age 7 in order to determine the extent to which poor medication adherence and cigarette smoke exposure mediate the relationship between caregiver mental health and child asthma morbidity. In addition, we will use the early data to identify developmental precursors for poor adherence and increased asthma morbidity at age 7.